Fundamental Elements to Consider When Making Medical Decisions

“A decision made by a person (‘P’) after he has reached 18 and when he has capacity to do so, that if – (a) at a later time and in such circumstances as he may specify, a specified treatment is proposed to be carried out or continued by a person providing health care for him, and (b) at that time he lacks capacity to consent to the carrying out or continuation of the treatment, the specified treatment is not to be carried out or

According to Beauchamp and Childress, the principle of autonomy asserts that a capable and competent individual is free to determine, and to act in accordance with, a self-chosen plan (Beauchamp and Childress as cited in Keating and Smith, 2010). Determining a patient's competence is critical in striking a proper balance between respecting the autonomy of patients who are capable of making informed decisions and protecting those who are not fully capable (Appelbaum, 2007). Tagging children incompetent solely on the basis of their age and not involving them in decision making regarding their health is violation of children's human right. Obtaining consent from parents, rather than children, negates one of the most important principles of medical ethics, which is patient autonomy. Nurses are obligated to promote the health of children by embracing children's right. Nurses' duties which stem out of respect for autonomy include both duties to ensure children's self determination is respected and to refrain from practices that interfere with the children's right of decision making (CARNA,

The Doctor and Patient relationship aspect of Medicine has changed drastically in the last twenty years. It has evolved from paternalism (the doctor makes the decision for the patient) to shared decision making where the patient is considered an equal partner in his/her own health related decisions. Informed consent is the cornerstone for this view. When a patient or a research subject makes an autonomous decision after understanding, the risks and benefits involved with the decision is Informed consent. Complete Informed consent covers the following components: competency, disclosure, comprehension and voluntary. Competency refers to the requirement for the individual to be of legal age and be mentally competent to understand the process.

Patient informed consent refers to the situation where the patient is fully informed on the consequences of their health care decision after which the patient gives the decision. For there to be informed consent, there are five elements that must be discussed. The first is the nature of the patient's decision then the applicable alternatives to the proposed intervention. Third are the risks, benefits and uncertainties associated with each of the alternatives. Fourth is the assessment of the patient's understanding and last is the acceptance of the intervention or an alternative by the patient. Before the patient's consent is considered to be valid, the patient's competency to make the decision must be addressed. The criteria for evaluating the patient's competency is clearly stated in section 3 of the 2005 Mental Capacity Act which states that provided the person is able to understand, retain and use information provided and to communicate their decision in any way such as talking or sign language, they are competent to make a decision. If a patient is treated against their refusal to consent, it amounts to the tort of battery or can also be considered the crime of assault. In addition to this, laws that touch on human rights reinforce the importance of the protection of the physical integrity of the individual in terms of their right to respect of their private life. Therefore, refusal of medical treatment is a human right.

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

In certain circumstances, informed consent requirements may be waived. These typically occur in the case of minors, who are not considered competent to make medical decisions, emergencies, or if the patient is not mentally competent enough to make an informed decision. Additionally, if the patient has chosen to waive the informed consent requirement, then the practitioner is

The decision of the Supreme Court could be considered ethically right. It was right to revoke the physicians’ decision, as it wasn’t in agreement with what the Canadian Health Care Consent act (HCCA) section 26 stipulates “A health practitioner shall not administer a treatment under section 25 if he has reasonable grounds to believe that the person, while capable and after attaining 16 years of age, expressed a wish applicable to the circumstances to refuse consent to the treatment.”3 Also, in medical ethics, it is the obligation of health care providers to allow the patients to make their own medical decisions. They should have autonomy in their decision making, that’s if they completely comprehend all the medical diagnosis, prognosis and all outcome of treatment options4. Starson had a full understanding of his options, he was fully

Consent for medical treatment is based on three legal ideals: the patient must be informed to make a decision, the patient cannot be intimidated into making a decision, and the patient must be competent (McCabe). In 1982, a study was held by Weithorn and Campbell showing the competency of four age groups (9,14,18, and 21 years-old) based on questions from the ideals aforementioned. The study concluded that fourteen year-olds’ competence and adult are analogous, while nine year-olds could partake in discussions based off of their treatment (Weithorn). The study conducted by Weithorn and Campbell, not only displays competence, but also the ability to comprehend the possible outcomes, and determine the importance of these possible outcomes relative to their own lives. With studies showing that at the age of fourteen the decisional capacity (prefrontal cortex) of the human brain is equal to that of an eighteen year-old, the legal age of consent must be lowered to fourteen years of age.

Although all citizens are protected the by the United States Constitution, minors are categorized as a special group; preventing them from making decisions without their guardian’s consent. Thus, under the parameters set by the Constitution, at the age of sixteen, Wendy should not be permitted to refuse chemotherapy treatment. Contrarily, in some states, if Wendy establishes her independence from her parents or at least is able to demonstrate a high level of maturity, she may be allowed to dictate her medical treatment (Mernikoff, 2001).

However, both the Courts’ case-by-case approach and the reasons recognised in Bellotti v. Baird as allowing a legitimate restriction of the constitutional rights of children are still echoed in the various State Minor Consent Laws that have been enacted in parallel with the development of the right to privacy within the Courts. They are also echoed in the provisions related to the parents and minors relationship found in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in which minor’s right to privacy is also seen in light of parents’ right to privacy. Obvious in this Act is also the unwillingness of the legislator to allow the HIPAA to disrupt both parents’ and children’s rights as these have been formed within “state

717). However, later cases argue against the autonomy of minors, allowing the state to override minors and their parents (Woolley, 2005, p. 717). Minors are refused the right to make their own decisions based on the assumption that they are immature and therefore do not possess the decision-making capacities to make a rational choice (Chen, 2007, p. 645).

There are many legal and ethical situations that healthcare providers will be faced with when providing medical treatment to either a child or an elderly adult. While there is often much discussion regarding the elderly and do not resuscitate orders, there are often times when the decisions for health care of a child may be overlooked. Some of the legal issues that may be faced by healthcare professionals are informed consent, confidentiality, reproductive services and child abuse. Patients have the right to decide what is done to their own bodies, but for children under eighteen, their parents decide for them. A major issue faced by healthcare professionals is parental refusal for treatment. Healthcare providers will be faced with many conflicting ethical and legal situations regarding refusal of a minor’s healthcare and treatment. These issues

Malone and Hinman quoted Justice Cardozo in Schloendorff v. Society of New York Hospital: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body,” exemplifying that anyone who is able to make decisions for themselves has a right to do so. However, the health care industry is more concerned with the general health of the public instead of an individual’s beliefs which causes an ethical dilemma.

For this ethical research report, I decided to base it on the article titled, “Who wears the braces? A practical application of adolescent consent.”. I chose this article from the title. It intrigued me to know what it was about and what it had to say and when I read on to find that it was talking about the role of informed consent in dentistry when it comes to adolescents, I was interested. I’ve always believed that, no matter the legal age, maturity isn’t based on that documented number. There is no “legal age” for maturity and capability of understanding. But when it comes to legal decision making in health care environments, I believed majority agreed with a child being too young to understand what they’re asking for. I was curious to know others views and opinions of this topic, especially in it were relating to a health care medical field. You would think that the responsibility of making a decision would go to the parent when it concerns health, but I was surprised and pleased to know that there is more to it than that.

The best possible resolution for this case would be to, first, to identify what Andrea would want to do for her end of life care. When her condition was deteriorating but before the cardiac arrest, the parents, social workers, nurses, and the physician should assess Andrea’s pain and suffering, asking her to express what she thinks she would want in the end. Harrison et al. (1997) supports this argument, claiming, “Parents and physicians should not exclude children and adolescents from decision making without persuasive reasons.” “Physicians should ensure that good decisions are made on behalf of their child patients” (as in Boetzkes & Waluchow, 2000, p. 163). It was also argued that, children of primary-school age, like Andrea, can participate in medical decisions, indicating their